不同剂量氢吗啡酮用于小儿先天性心脏病开胸术后静脉镇痛的效果  

The analgesic effect of different does of intravenous hydromorphone on postoperative analgesia in infants with congential heart disease after open heart surgery

作　　者：胡洁[1] 汲玮 林琳[1] 张瑞冬[1] 张马忠[1] 

机构地区：[1]上海交通大学医学院附属上海儿童市医学中心麻醉科,上海200127

出　　处：《上海医学》2015年第12期871-874,共4页Shanghai Medical Journal

基　　金：国家自然科学基金项目资助(81202597)

摘　　要：目的评价不同剂量氢吗啡酮用于小儿先天性心脏病开胸术后静脉镇痛的效果。方法选取60例年龄为3个月~3岁择期行先天性心脏病纠治术的患儿,术毕即予护师控制镇痛(NCA),将患儿随机分入3组,每组20例。氢吗啡酮低剂量组,氢吗啡酮背景剂量为3μg·kg^(-1)·h^(-1),NCA剂量为3μg/kg;氢吗啡酮高剂量组,氢吗啡酮背景剂量为4μg·kg^(-1)·h^(-1),NCA剂量为4μg/kg;吗啡组,吗啡背景剂量为15μg·kg^(-1)·h^(-1),NCA剂量为15μg/kg。3组患儿同时静脉输注咪达唑仑2μg·kg^(-1)·min^(-1)作为镇静治疗,待撤离呼吸机后停止输注。记录患儿的一般情况;在术后3、6、12、24和48h各时间点,记录患儿的舒适度-行为量表(Comfort-B)评分、Ramsay镇静评分;记录NCA次数、不良反应(恶心呕吐、皮肤瘙痒、过度镇静)和拔除气管导管后因呼吸抑制而再插管等情况。结果 3组患儿术后48h内各时间点的Comfort-B评分、Ramsay镇静评分,术后第1天的NCA次数,拔除气管导管时间,术后恶心呕吐发生率的差异均无统计学意义(P值均>0.05)。吗啡组患儿术后第2天的NCA次数显著少于氢吗啡酮低剂量组和氢吗啡酮高剂量组(P值均<0.05)。吗啡组患儿皮肤瘙痒发生率显著高于氢吗啡酮低剂量组和氢吗啡酮高剂量组(P值均<0.05);氢吗啡酮高剂量组发生过度镇静1例,但过度镇静发生率与氢吗啡酮低剂量、吗啡组的差异均无统计学意义(P值均>0.05)。3组患儿均未发生拔除气管导管后因呼吸抑制而再插管的情况。结论先天性心脏病患儿开胸术后合用2μg·kg^(-1)·min^(-1)咪达唑仑镇静行机械通气时,氢吗啡酮背景剂量3μg·kg^(-1)·h^(-1)、NCA剂量3μg/kg方案的镇痛效果好,且不良反应较少。Objective To compare the analgesic effects of different doses of intravenous hydromorphone on postoperative analgesia in infants with congenital heart disease （CHD） after open heart surgery. Methods Sixty CHD infants, aged from 3 to 36 months, undergoing elective cardiac surgery were randomly divided into 3 groups （n = 20 each） to receive postoperative nurse controlled analgesia （NCA）= low dose hydromorphone group （hydromorphone, 3μg·kg-1·h-1 basal infusion, NCA： 3μg/kg）, high dose hydromorphone group （hydromorphone：4μg·kg-1·h-1 basal infusion, NCA; 4 μg/kg）, and morphine group （morphine：15 μg·kg-1·h-1 basal infusion, NCA= 15μg/kg）. All patients were also sedated with a continuous midazolam infusion at 2μg·kg-1·min-1 until extubation. Demographic data, Comfort-B scores, Ramsay sedation scores, the number of NCA boluses, adverse reactions （such as nausea and vomiting, pruritus, over-sedation） and respiratory depression after extubation were evaluated at 3 h, 6 h, 12 h, 24 h and 48 h after Surgery. Results There were no significant differences in terms of comfort-B scores or Ramsay sedation scores 48 h after surgery between groups （all P〈0.05）. Neither were the demand of NCA boluses on Day 1 postoperatively, the time of extubation, or the incidence of nausea or vomiting between groups （all P〈0.05）. There were significantly fewer demands of NCA boluses on Day 2 postoperatively and higher incidence of pruritus in the morphine group as compared with the other two groups （all P〈0.05）. One patient in the high dose hydromorphone group was over sedated, but there was no significant difference in the incidence of over-sedation between groups （both P〉0.05）. No patient experienced respiratory depression after extubation. Conclusion NCA 3 μg/kg and basal infusion of hydromorphone 3μg·kg-1·h-1 in association with a continuous midazolam infusion at 2 μg · kg-1·min-1 during mechanical ventilation can provide appropriate analgesia and less side effect

关 键 词：氢吗啡酮 术后静脉镇痛 先天性心脏手术 小儿 

分 类 号：R726.1[医药卫生—儿科]